政府為促進國人健康,並以社會保險的形式分攤弱勢團體的就醫需求,於民國84年開始實施全民健康保險,實施至今超過20年,而且納保率已高達99%。重大傷病證明是全民健保的主要特色之一,持有重大傷病證明卡的病患就醫時可免除部分負擔,減輕罹患重病患者的醫療負擔。截至106年2月約有4%國人領有重大傷病證明卡,但其醫療費用佔健保支出超過 27%,預期這兩個數值會因人口老化而逐年上升,使得重大傷病的相關議題越來越受到重視。 本文以全民健保資料庫中的重大傷病證明明細檔(HV)為基礎,以2005年百萬人抽樣檔之承保紀錄檔(ID)、門診處方及治療明細檔(CD)及住院醫療費用清單明細檔(DD)輔助,探究罹患重大傷病發生及死亡議題,提出判定發生、死亡的準則,並且依此分析各種疾病發生率與死亡率的關係。另外,本文也使用資料庫內容驗證重大傷病患者與非重大傷病患者之間醫療費用的差異,研究也發現新發生的病患就醫率偏低,並以國際疾病分類代碼驗證重大傷病門診處方及治療明細檔(HV_CD)資料抓取的準確性。 / Taiwan started National Health Insurance (NHI) in 1995, for more than 20 years, and more than 99% people are covered in this social insurance plan. It is believed that the NHI has further enhanced the health of Taiwan’s people.Catastrophic illness(CI)card is one of the key features in the NHI and people with this card can enjoy waiver of copayment and other medical benefits which reduce the financial burden of CI patients. For example, about 4% Taiwan’s population were with the CI card and they spend more than 27% of total medical expenditure of NHI. Since the probability with CI increases with age, the population aging and prolonging life are expected to worsen the financial burden of the NHI. Our goal is to explore the medical need and its trend of CI patients, via the data from the NHI Database, including Registry for catastrophic illness patients(HV), Registry for beneficiaries(ID), Inpatient expenditures by admissions(DD)and HV’s Ambulatory care expenditures by visits(HV_CD). Since the medical records do not cover all the required information, we propose several criteria for data analysis, such as the rules of judging whether the patients incur CI and the CI patients passed away. We found that the incidence rates and mortality rates of CI patients decrease with time. Also, there are questions about the data quality regarding the HV_CD database and more than 50% new CI patients do not have medical records of CI diseases.

臺灣在2015年高齡人口（65歲以上）比例超過12.5%，依照國家發展委員會的2016年人口推估，預計將於2018年正式邁入高齡社會（高齡人口比例14%），2026年更突破20%的門檻，人口老化速度持續加快。因為身體機能隨年齡增長等因素逐漸老化，高齡人口的就醫需求通常也較多，包括就醫金額、就醫次數，根據中央健康保險署2014年統計，高齡人口比例約為12.0%，但其醫療費用卻佔總費用37.6%。因此本文以探討高齡人口就醫特性為目標，透過高齡人口就醫行為去了解醫療現況，並評估因老化而引發的醫療資源。 本文以高齡人口特性及就醫需求為研究方向，探討近十年高齡人口就醫需求的基本特性，如：醫療使用率、平均就醫次數及平均醫療費用。接著以高齡人口就醫選擇集中度做為出發點，計算各疾病下的就醫集中程度，探討是否高齡人口會隨著不同疾病而有不同的就醫行為。研究結果顯示年紀越大的高齡人口，醫療使用率反而下降，但平均總醫療花費隨著年齡增加亦跟著上升；另外在不同的疾病下會有不同的就醫行為，當就醫地選擇越一致其死亡率也越低。計算依據為全民健康保險資料庫2005年百萬高齡人口抽樣檔，包括承保資料檔(ID)、門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)，以六十五歲以上高齡人口為研究對象，探討其醫療利用行為及就醫習性。 / The population aging is speeding up in Taiwan. The elderly population (65 years and older) is more than 12.5% in 2015 and, according to the population projection of National Development Council, it is expected to reach 14% and 20% in 2017 and 2026, respectively. The elderly usually require more medical attention, partly due to the fact that the human organs degenerate with time. For example, in 2014, the proportion of elderly is about 12.0% and they account for 37.6% of total medical expenditure (Source: National Health Insurance Administration). Taiwan’s total medical expenditure will continue to grow and we need to understand the medical needs of Taiwan’s elderly, in order to cope with the need of aging society. Therefore, we use the data from the National Health Insurance Research Database (NHIRD) to explore the medical needs and behaviors of receiving medical care of Taiwan’s elderly. The dataset used in this study is a sample (one million people aged 65 and beyond, about 46% of total population) of Taiwan’s elderly and the dataset contains the Registry for beneficiaries (ID), outpatient visits (CD), and inpatient admissions (DD). Our analyses show that almost all elderly have at least one medical visit annually and their diseases are more diverse than those of younger generations. Also, the elderly have larger inertia in medical visits and, for example, the proportion of choosing the same medical institution is higher. The results of this study can serve as a reference to future policy planning and resource allocation for the elderly.

Magister Public Health - MPH / The introduction of National Health Insurance (NHI) and the Ideal Clinic Monitoring System have highlighted gaps and challenges with regard to medicine supply management (MSM) at primary health care (PHC) facilities. PHC facilities are the first point of contact communities have for their health needs, however, frequent stock-outs of medicines at PHC facilities in uMkhanyakude district, a rural district in KwaZulu-Natal, and have raised questions as to how medicine stock is managed at these facilities.

The issue of national health care has actively plagued the 20th century political spectrum in both the U.S. and the United Kingdom. It has been an issue of astounding resilience and vexation, alluding almost all simple-quick answers while consuming an ever increasing amount of public resources. There have been three principal time periods when both the United States and Great Britain have actively addressed universal coverage: the 1910s; the 194Os; and the 1990s. This dissertation extends John Kingdon's theory on policy agenda formation by examining the aforementioned debates. The conclusions that come from this study are four fold. (1) Contemporaneous interactions can occur between nations. (2) Century-long longitudinal development of a single policy area is possible and is illustrated. (3) Kingdon's policy streams approach can be utilized to conduct a comparative analysis of the policy agenda formation process. (4) Kingdon's conceptual model is more accurate at depicting the policy agenda formation process of the British parliamentary system than it is for the divided government structure of the U.S. / Ph. D.

The tax system in South Africa makes provision for every South African citizen to contribute to a greater or lesser extent to funding the National Health Insurance (NHI), either through VAT or PAYE. However, as a result of the high unemployment rate, a large gap exists between tax and non-tax contributors. The question can now be asked whether it is fair that just a small percentage of taxpayers are responsible for the total funding of the NHI. Furthermore, it could be asked whether the taxpayer is aware of the additional tax burden the NHI will impose on him/her. The purpose of this research was to investigate three countries, namely, Brazil, Spain and Germany, where some form of NHI is in operation, in order to find a possible appropriate funding model for South Africa's NHI and, ultimately, to make conclusions and recommendations based on the outcomes. It was subsequently found that, although the taxpayer should be more heavily taxed in order to fund the NHI, there are a few other possibilities for distributing the tax burden more evenly. However, the impact of the proposed adjustment to increase VAT could have a negative impact on the non-taxpayer and might contribute to greater poverty in South Africa. / MCom (South African and International Taxation), North-West University, Potchefstroom Campus, 2014

The tax system in South Africa makes provision for every South African citizen to contribute to a greater or lesser extent to funding the National Health Insurance (NHI), either through VAT or PAYE. However, as a result of the high unemployment rate, a large gap exists between tax and non-tax contributors. The question can now be asked whether it is fair that just a small percentage of taxpayers are responsible for the total funding of the NHI. Furthermore, it could be asked whether the taxpayer is aware of the additional tax burden the NHI will impose on him/her. The purpose of this research was to investigate three countries, namely, Brazil, Spain and Germany, where some form of NHI is in operation, in order to find a possible appropriate funding model for South Africa's NHI and, ultimately, to make conclusions and recommendations based on the outcomes. It was subsequently found that, although the taxpayer should be more heavily taxed in order to fund the NHI, there are a few other possibilities for distributing the tax burden more evenly. However, the impact of the proposed adjustment to increase VAT could have a negative impact on the non-taxpayer and might contribute to greater poverty in South Africa. / MCom (South African and International Taxation), North-West University, Potchefstroom Campus, 2014

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)

本次研究使用全民健康保險研究資料庫2005承保抽樣歸人檔(LHID2005)，共40萬人的承保資料，針對肺癌患者的特徵進行分析，並與美國國家癌症研究所的肺癌資料作比較，罹患肺癌的人數都呈現男性多於女性，罹癌年齡的最高峰同樣落在65歲至74歲。 接著，將門診處方及治療明細檔和住院醫療費用清單明細檔進行彙整，整理出肺癌患者在2005年至2012年之間的門診費用以及住院費用，並比較不同項目的差距及特徵，門診費用以用藥明細點數最高，住院花費前五名的項目為葯費、病房費、放射線診療費、檢查費以及治療處置費。 最後，建構肺癌治療的多重型態模型，治療方式包含手術治療、放射線治療、化學治療，估計不同狀態之間的轉換力，進而算出五年定期躉繳肺癌保單之純保費。 / This study used Longitudinal Health Insurance Database 2005 (LHID2005) from Taiwan’s National Health Insurance Research Database (NHIRD). Screening the 400,000 insured of NHIRD to select the lung and bronchus cancer patients. This study analyzed and described their characteristics. Furthermore, it compared Taiwan’s lung and bronchus cancer data with the data in the United States derived from National Cancer Institute of the USA. The results revealed that the number of male patients is more than female patients and lung cancer is most frequently diagnosed among people aged 65-74 in both countries. Another aim was to sum up the lung cancer medical cost in 2005 to 2012 from NHIRD database, including ambulatory care expenditures by visits and inpatient expenditures by admissions. The highest cost of outpatients was medicine fee. The top five inpatient expenditures were medicine fee, ward fee, radiation therapy fee, inspection fee and therapeutic treatment fee. Finally, this study constructed a multiple state model of lung cancer treatment, including surgery, radiotherapy, chemotherapy. Estimating the transition intensities from multiple state model to calculate the pure premium of a five-year lung cancer policy.

通常在談論健康照護的公平性時，主要分成垂直公平與水平公平兩種。在健康照護財務面的垂直公平意指有較高所得或經濟能力者，應支付較高的保費；水平公平意指，有相同所得或經濟能力者，應支付相同的保費。在健康照護提供面的垂直公平意為有不同需要者，應有不同的治療；水平公意為有相同需要者，應有相同的治療。然而由於提供面的垂直公平較難界定其程度，故多數學者在提供面僅談水平面，而本研究亦採相同的論點來分析被保險人在保費負擔與其醫療費用支出之公平性問題。 本研究資料係採用鄭文輝教授等在1996、1997年研究之原始資料，包括85年度的健保承保檔、醫療利用紀錄檔及財稅資料中心之綜合所得稅檔。利用逐步迴歸或probit二分法迴歸方式進行保險對象自付保費負擔與其醫療費用支出之間的公平性探討。 本研究實證結果簡述如下： 一、在被保險人自付保費負擔公平性方面，存在違反垂直公平或水平公平的情況，可能之原因如下： 1.投保金額分級表的上下限差距過小，使所得愈高，其保費增加的比例形成累退。 2.在投保金額分級表中每一等級仍有上下限之規定。 3.三類投保金額過低，與其所得分配差異過大。 4.眷口數計費採論口計費，而通常所得愈低，眷口數有愈多的現象，故論口計費將使得所得較低者之保費負擔加重或同樣所得水準者，負擔不相同的保費情形。 5.各類目均適用同一費率，且同一類目之自付比率均相同，無法有效發揮所得重分配效果。 二、個人醫療費用支出的差異及其與保費或所得高低之間的公平性 1.門診費用受到所得因素影響，個人所得愈高，門診費用有愈高的現象；且因為重症而就醫者仍為少數，以其他一般症狀就醫者仍占多數。 2.重症患者或罹患十大死因患者，多以所得較低或保費較低者居多，顯示全民健保的開辦，確實為較低收入者或較弱勢族群減輕就醫上之財務負擔。 3.由於男性罹患重症之比率較女性高，故雖然女性的門診次數與費用較男性高，但在個人總醫療費用上均以男性較高，可能與其生活、就醫習慣有關；而隨著年齡的增加，個人醫療利用情形與費用均逐漸增加，但對於中壯年人口之男性而言，個人醫療費用有逐漸上升趨勢，值得注意。 故對我國全民健保之政策性建議，為使所得重分配的效果得以發揮，在保費負擔方面，建議提高投保金額分級的上下限差距，且縮短等級之間的上下限，分級數愈多，愈能表現出公平性；眷口數計費改採論被保險人計費；三類投保金額與自付比率應調高。在醫療費用分配方面，為抑制所得較高或保費負擔較多者對醫療資源的不當利用，本文建議改採定率部分負擔、改善城鄉醫療資源分配，保障內容改採保大不保小，抑制不必要及小額的醫療支出，讓社會保險的自助、互助及他助精神得以發揮。 未來期能利用數年的歷年資料，來分析個人或家戶在時間上之所得、保費負擔與醫療費用支出三者之間的分配情形，以更能深入瞭解政策之改變，帶來之效果。 / Equity is widely acknowledged to be an important policy objective in the health care field. The principle comes in two versions: a horizontal version (persons in equal need should be treated the same) and a vertical version (persons with greater needs should be treated more favourably the those with lesser needs). The purpose of this study is to investigate the equity between the insurees’ premium burden and their medical care expenditures in Taiwan's National Health Insurance Scheme. The sample combines two sets of data, which are data for the insured and their dependents’ premiums and medical expenditures of utilization obtained from the Bureau of NHI ; individual income tax return data obtained from the Data Processing Center of the Ministry of Finance. According the data, we will be able to use the regression model of stepwise and probit methods to analysis the purpose of this study. The major findings are twofold: First, at present the regulations in the premium exists the horizontal and vertical the inequity, so the system can't bring the income replaecment, About medical dilvery, NHI is favorable person lower-income. To achieve ability to pay, the gap between the upper and bottom of insured payroll-related amount class should be lengthened. And to lighten the burden of insuree with dependents. Second, in the medical delivery deductible amounts paid by beneficiaries will be changed from fixed amounts to fixed rate to control the wasting medical resource.

Section 27(1)(a) of the Constitution of the Republic of South Africa, 1996, entrenches everyone's right of access to health care services. The purpose of this dissertation is to determine the manner in which this right must be interpreted and implemented in order to alleviate poverty to the optimal extent possible, in South Africa. As a point of departure, the relationship between poverty and health, as well as the theoretical basis of poverty, is addressed in terms of soft law. Thereafter, the theoretical basis of the right of access to health care service is analysed and explained from both an international and a South African perspective. This is followed by an investigation into international law. The manner in which the United Nations International Covenant on Economic, Social and Cultural Rights is interpreted and implemented and whether or not this contributes to poverty alleviation, is investigated. This is followed by an analysis of the right in terms of the Constitution and case law. Particular attention is paid to the manner in which the courts interpret the right of access to health care services. It is then determined whether the state is implementing the right in such a manner as to contribute to the optimal alleviation of poverty, in South Africa. Finally, a conclusion is reached and recommendations are made as to ways in which the right can be interpreted and implemented to reduce poverty to the optimal extent possible, in South Africa. / Thesis (LL.M.)--North-West University, Potchefstroom Campus, 2010.